Routine childhood vaccination linked to long-term schooling attainment among adults in India

Vaccines have reduced the global burden of disease by preventing an estimated 2 to 3 million deaths worldwide each year. In India, the reduction in annual under-five deaths, from 3.4 to 1.2 million between 1990 and 2015, was largely due to expansions in coverage of routine childhood vaccination. Vaccines have been linked to increased economic productivity as well as improved cognition, growth, and schooling among children. While the long-term health benefits of vaccination are well known, little evidence exists on the link between routine childhood vaccination and long-term schooling attainment among adults in low- and middle-income countries.

In this study, researchers analyzed levels of schooling attainment in years among adults born during or after the implementation of India's Universal Immunization Programme (UIP) (intervention) compared to adults born before the implementation (control). District-level data from the rollout of India's UIP between 1985 and 1990 was matched to schooling data from the National Family Health Survey of India, 2015-2016, a cross-sectional survey that collects information on health and family welfare indicators. The study included 109,908 non-migrant individuals who were born within five years of UIP rollout (1980-1995).

We compared schooling attainment of individuals who were born after the introduction of UIP with that of those who were similar, i.e., they lived in the same household or community, but were born just before the UIP."

Arindam Nandi, study author and CDDEP Senior Fellow

Utilizing fixed-effects linear regression models adjusted for socioeconomic and demographic factors, community-level infrastructure, amenities, and access to healthcare, the study found that India's UIP was associated with 0.2-0.3 additional schooling grades among adults. Specifically, in household, village or city ward, district, and state fixed-effects analysis, adults born during or after UIP rollout attained 0.18, 0.23, 0.29, and 0.25 additional schooling grades respectively compared to adults born before UIP rollout. All results were statistically significant (p<0.05). In subgroup analyses, the link between UIP implementation and schooling attainment was significant among women, unmarried women, members of households in rural and urban areas, general caste and other backward classes, and individuals in the top two wealth quintiles.

Overall, results indicate that routine childhood vaccination is associated with improved schooling attainment among adults in India, which adds to the literature on the long-term non-health benefits of vaccines.

"This study is an important addition to a small but growing literature on the broader cognitive and schooling benefits of routine childhood vaccines in low- and middle-income countries. The findings reinforce the need for universal vaccination coverage among children," adds Nandi.